Little information exists regarding the long-term effects of cocaine use during pregnancy and the effects of postpartum cocaine use on the child's environment. This proposal will evaluate prospectively a large, well- established cohort of substance-using women and their offspring to define the long-term effects of prenatal cocaine exposure. The strengths of the study include exceptional follow-up rates, detailed assessment of all substances, measurement of potential confounding variables, and an assessment battery targeted to specific hypotheses. Women were enrolled during pregnancy and follow-ups occurred at birth, 1, and 3 years. Cocaine and crack use were assessed for each trimester of pregnancy and for each follow-up period. Data were also collected on all other drug use, sociodemographic factors, maternal psychological characteristics, the current environment, and child characteristics. This allows us to: (1) evaluate the relationship between prenatal cocaine/crack use and child outcome while controlling for these confounding factors; and (2) explore the effect of the current environment on the development of children who potentially have been made vulnerable by prenatal substance exposure. Important findings have emerged from the ongoing analyses of our data. At each follow-up phase, we have found direct effects of prenatal cocaine exposure on the development of the central nervous system. At birth, we detected neurological and neurobehavioral effects on the EEG-sleep studies and the Brazelton NBAS, respectively. These early indicators have now been confirmed as we have found that prenatal cocaine exposure leads to slowed motor development at 1 year. At both 1 and 3 years, exposed children were reported by their mothers to be fussier and more difficult. At 3 years, prenatal cocaine exposure was associated with decreased 10 scores, increased number of behavior problems, and decreased head circumference. In general, these effects were associated with exposure during the first trimester. Cocaine use also has effects on the environment in which the child is raised. Women who used cocaine/crack during pregnancy also used more alcohol, tobacco, and marijuana, during pregnancy and through the postpartum years. Current cocaine users also provided less stimulating and organized home environments than non-users. Thus, the children are directly exposed to the effects of cocaine prenatally and indirectly exposed to the effects of cocaine through their environment. This is a proposal to assess the children at 7 years of age. This age provides an opportunity to evaluate new dimensions of functioning. As more complex cognitive demands are made upon the child, subtle dysfunctions of the CNS that could not be measured earlier will become apparent. We will assess the physical, developmental, behavioral, and neuropsychological characteristics of the child, as well as the current substance use and sociodemographic, psychological, and environmental characteristics of the mother. The longitudinal design and careful attention to covariates will allow a more complete description and understanding of the long-term effects of prenatal cocaine use.